A Queueing Model of Patient Flow for Stroke Networks to Estimate Acute Stroke Transfer Capacity

TL;DR

This study develops a queueing model to estimate how patient transfer rates and ICU capacity affect the likelihood of capacity overflow at stroke centers, aiding resource planning and network optimization.

Contribution

It introduces a queueing model specifically for stroke patient transfers to quantify capacity overflow risks in stroke networks.

Findings

Increasing transfer rates raises overflow probability.

Adding beds or reducing transfer rates can mitigate overflow.

Model helps plan resource allocation in stroke networks.

Abstract

Background: Most acute stroke (AS) patients in the United States are initially evaluated at a primary stroke center (PSC) and a significant proportion requires transfer to a comprehensive stroke center (CSC) for advanced treatment. A CSC typically accepts patients from multiple PSCs in its network, leading to capacity limits. This study uses a queueing model to estimate impacts on CSC capacity due to transfers from PSCs. Methods: The model assumes that the number of AS patients arriving at each PSC, proportion of AS patients transferred, and length of stay in the CSC Neurologic Intensive Care Unit (Neuro-ICU) by type of AS are random, while the transfer rates of ischemic and hemorrhagic AS patients are control variables. The main outcome measure is the "overflow" probability, namely, the probability of a CSC not having capacity (unavailability of a Neuro-ICU bed) to accept a transfer. Data simulations of the model, using a base case and an expanded case, were performed to illustrate the effects of changing key parameters, such as transfer rates from PSCs and CSC Neuro-ICU capacity on overflow capacity. Results: Data simulations of the model using a base case show that an increase of a PSC's ischemic stroke transfer rate from 15% to 55% raises the overflow probability from 30.62% to 36.13%. Further simulations of the expanded case show that to maintain an a priori CSC overflow probability of 30.62% when adding a PSC with a AS transfer rate of 15% to the network, other PSCs would need to decrease their transfer rate by 12.5% or the CSC Neuro-ICU would need to add 2 beds. Discussion: A queuing model can be used to estimate the effects of change in the size of a PSC-CSC network, change in AS transfer rates, or change in number of CSC Neuro-ICU beds of a CSC on its capacity on the overflow probability in the CSC.